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General NPI Number Information
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NPI Number | 1497373732
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Entity Type | Individual
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Provider Name | JOSHUA DEAN ROBERTS OD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 460 N 325 E
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City | OGDEN
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State | UT
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Zip | 84404-3578
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Country | US
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Telephone | 801-614-7239
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Fax |
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Provider Business Mailing Address
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Address Line | 256 W ANTELOPE DR APT D
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City | LAYTON
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State | UT
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Zip | 84041-6050
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Country | US
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Telephone | 435-213-0784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11839138-9934
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License Number State | UT
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